Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208100000X | Physical Medicine & Rehabilitation Doctor | 242731 | MA |
N | 2081S0010X | Sports Medicine | 67960 | GA |
N | 213ES0000X | Sports Medicine | 67960 | GA |
NPI | 1124293089 |
---|---|
Provider Name | David Michael Popoli |
First Address | Fayetteville, GA 30214-4543 |
Second Address | Fayetteville, GA 30214-4543 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/04/2008 |
Last Update Date | 19/07/2012 |